Provider Demographics
NPI:1972585545
Name:HATFIELD, LISA ANN (OD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:HATFIELD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:HASLAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3040 S MUSKOGEE AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-5485
Mailing Address - Country:US
Mailing Address - Phone:918-431-1444
Mailing Address - Fax:918-431-1555
Practice Address - Street 1:3040 S MUSKOGEE AVE STE 109
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-5485
Practice Address - Country:US
Practice Address - Phone:918-431-1444
Practice Address - Fax:918-431-1555
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2305152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100765160AMedicaid
OK2605260OtherUNITED HEALTHCARE
OKU81805Medicare UPIN